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The second victim phenomenon among German emergency medical technicians: a cross-sectional study based on the SeViD

Hartwig Marung¹, Victoria Klemm², Reinhard Strametz²

¹Institute for Safety of Patients and Health Professionals (ISPP), MSH Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany. hartwig.marung@medicalschool-hamburg.de.

BMC Emergency Medicine

|July 28, 2025

Abstract

Background:

Emergency medical technicians (EMTs) frequently encounter high-stress, traumatic events, making them vulnerable to the second victim phenomenon (SVP), a state of emotional distress following adverse patient-related incidents. While SVP is well documented among physicians and nurses, research on EMTs remains limited. This study examines the prevalence, risk factors, symptom burden, and preferred support strategies for SVP among German EMTs.

Methods:

A cross-sectional survey was conducted using the validated SeViD questionnaire (Second Victims in German-speaking countries). The survey assessed SVP prevalence, symptom severity, and preferred support measures. Binary logistic regression was performed to identify predictors of SVP and symptom burden. Descriptive statistics were used to summarize demographic and occupational characteristics.

Results:

Among the 699 respondents, 528 (75.5%) completed the survey. The prevalence of SVP was 65.3%, with 53.3% reporting SVP within the past 12 months. The most common triggering events were unexpected patient deaths (37.1%) and aggressive behavior from patients or relatives (19.1%). Logistic regression revealed that professional experience (OR = 1.055, p < 0.001) and employment in ground-based intensive care transport (OR = 2.444, p = 0.004) were risk factors for SVP, whereas male gender (OR = 0.392, p < 0.001) and conscientiousness (OR = 0.765, p = 0.033) were factors associated with lower risk. Higher extraversion was associated with lower symptom burden (OR = 0.754, p = 0.013). The most valued support measures were legal consultation and professional counseling.

Conclusions:

SVP is highly prevalent among EMTs and has significant psychological and emotional consequences. Greater work experience and intensive care transport roles increase SVP risk, whereas conscientiousness and extraversion appear protective. The implementation of structured peer support programs may help mitigate the impact of SVP.

Keywords:

Emergency medical technicians Emotional distress Occupational health Paramedics Patient safety Psychological distress Second victim

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